Nairobi's hard task of fighting cholera outbreak

A dumpsite next to Muthurwa market in Nairobi (Photo: Courtesy)

Denial, poor preparedness and a lack of a medical emergency response strategy might have contributed to the death of several people who contracted cholera.

At least 14 people have died in the last few weeks and more than 400 new cases reported since the outbreak was first publicly reported in Nairobi, with experts warning that many factors beleaguering the health system and the County Government might work against efforts to contain the outbreak.

Now, authorities stand accused of mishandling an outbreak that could turn into an epidemic.

Investigations by the Sunday Standard reveal that dozens of cholera cases within the city are undocumented.

One hospital in Nairobi’s Embakasi area recorded 22 cholera cases in a span of two weeks. All the patients frequented one eatery.

To date, the establishment along Airport North Road remains open to the public and service continues unhampered.
These point to the possibility of there being more than the officially noted 400-odd cases that grew from an initial 20 that were first made public after a wedding in Karen.

“Unless health officials dedicate themselves to finding the sources of this contamination, the outbreak might get worse,” Professor Sam Kariuki, the Chief Research Scientist and Director of the Centre for Microbiology Research at the Kenya Medical Research Institute said.

The World Health Organisation (WHO) advises that surveillance and investigation through the deployment of rapid response teams, training community health workers to conduct house-to-house case identification, and referral to cholera treatment centres is key to containing the disease.

While easily treatable and preventable, experts say systematic cheating of the county’s health system through endemic corruption, littered streets burst sewers and a construction boom in the capital have formed an unholy union to make the containment of the disease problematic.

Health Cabinet Secretary Cleopa Mailu has blamed the outbreak of cholera on food handlers and water shortage while announcing the closure of two establishments -- a hotel and a restaurant.

The sole reason for the closure of the two, San Valencia and Jacaranda Hotel, was that they provided catering services at a trade expo at Kenyatta International Convention Centre, and two Cabinet Secretaries were hospitalised with cholera-like symptons.

Jacaranda Hotel says none of their guests has displayed symptoms of the disease prior to or before the closure notice. It however says four stool samples taken from over 240 staff tested positive for cholera and the staff were subsequently given sick leaves and would only be allowed back to work after subsequent results prove they have fought off the bug.

Just like the 22 cases recorded in an Embakasi hospital, no health teams were deployed to their homes, to interview them or retrace their last movements to try and establish the source of the disease. Another hospital in Nairobi’s South B has also treated and discharged more than 20 patients who tested positive for the disease.

None of the patients we talked to has had any interaction with a public health officer.

In written memos and further communication to the health officials seen by the Sunday Standard, Jacaranda Hotel repeatedly asks the Ministry of Health (MoH) to provide further details on why the establishment was ordered to close and whether there are any health codes that the hotelier had violated.

Almost a week later, MoH officials remain tight lipped.

In an opinion to our sister publication The Standard earlier in the week, Dr Kipruto Chesang argues that the number of those infected and sick might be higher than those reported.

“The numbers we are seeing being reported of the sick are the tip of the iceberg, it is an epidemic of vast proportions. The second factor of high density of susceptible population, means that resources such as water, sewer, waste disposal and toilets in a limited geographic area with many people, are strained,” Dr Chesang, who is a Public Health Society of Kenya Council member said.

He says vaccination can be a key step towards tackling outbreaks. But before we get there, a few life-threatening chinks in system need to be fixed.

According to World Health Organisation cholera is an acute enteric infection caused by the ingestion of bacterium vibrio cholerae present in faecally contaminated water or food.